{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:22:15Z","timestamp":1787167335970,"version":"build-2736575974"},"reference-count":53,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,8,1]]},"abstract":"<jats:p>Objective.Critically ill neonates are at high risk for vascular catheter\u2013related bloodstream infection (CRBSI), most often caused by coagulase-negative staphylococci. Most CRBSIs with long-term devices derive from intraluminal contaminants. The objective of this study was to ascertain the safety and the efficacy of a vancomycin-heparin lock solution for prevention of CRBSI.<\/jats:p>\n                  <jats:p>Methods.A prospective, randomized double-blind trial was conducted during 2000\u20132001 at a community hospital level III NICU. Very low birth weight and other critically ill neonates with a newly placed peripherally inserted central venous catheter were randomized to have the catheter locked 2 or 3 times daily for 20 or 60 minutes with heparinized normal saline (n = 43) or heparinized saline that contained vancomycin 25 \u03bcg\/mL (n = 42). The origin of each nosocomial bloodstream infection (BSI) was studied by culturing skin, catheter hubs, and implanted catheter segments and blood cultures, demonstrating concordance by restriction-fragment DNA subtyping. Surveillance axillary and rectal cultures were performed to detect colonization by vancomycin-resistant organisms. The main outcome measures were (1) CRBSIs and (2) colonization or infection by vancomycin-resistant Gram-positive bacteria.<\/jats:p>\n                  <jats:p>Results.Two (5%) of 42 infants in the vancomycin-lock group developed a CRBSI as compared with 13 (30%) of 43 in the control group (2.3 vs 17.8 per 1000 catheter days; relative risk: 0.13; 95% confidence interval: 0.01\u20130.57). No vancomycin-resistant enterococci or staphylococci were recovered from any cultures. Vancomycin could not be detected in the blood of infants who did not receive systemic vancomycin therapy. Twenty-six neonates (8 vancomycin-lock group, 18 control group) had at the end of a catheter-lock period asymptomatic hypoglycemia that resolved promptly when glucose-containing intravenous fluids were restarted.<\/jats:p>\n                  <jats:p>Conclusions.Prophylactic use of a vancomycin-heparin lock solution markedly reduced the incidence of CRBSI in high-risk neonates with long-term central catheters and did not promote vancomycin resistance but was associated with asymptomatic hypoglycemia. The use of an anti-infective lock solution for prevention of CRBSI with long-term intravascular devices has achieved proof of principle and warrants selective application in clinical practice.<\/jats:p>","DOI":"10.1542\/peds.2004-2674","type":"journal-article","created":{"date-parts":[[2005,7,1]],"date-time":"2005-07-01T20:59:51Z","timestamp":1120251591000},"page":"e198-e205","source":"Crossref","is-referenced-by-count":135,"title":["A Vancomycin-Heparin Lock Solution for Prevention of Nosocomial Bloodstream Infection in Critically Ill Neonates With Peripherally Inserted Central Venous Catheters: A Prospective, Randomized Trial"],"prefix":"10.1542","volume":"116","author":[{"given":"Jeffery S.","family":"Garland","sequence":"first","affiliation":[{"name":"Department of Pediatrics, St Joseph's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen P.","family":"Alex","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, St Joseph's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly J.","family":"Henrickson","sequence":"additional","affiliation":[{"name":"Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy L.","family":"McAuliffe","sequence":"additional","affiliation":[{"name":"Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis G.","family":"Maki","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2005,8,1]]},"reference":[{"key":"2021121003171748800_R1","unstructured":"Trotter CW. 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